Provider Demographics
NPI:1194908996
Name:JS ANESTHESIA AND PAIN MANGEMENT
Entity type:Organization
Organization Name:JS ANESTHESIA AND PAIN MANGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-717-7111
Mailing Address - Street 1:PO BOX 126595
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92112-6595
Mailing Address - Country:US
Mailing Address - Phone:858-717-7111
Mailing Address - Fax:760-269-3103
Practice Address - Street 1:555 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3043
Practice Address - Country:US
Practice Address - Phone:760-256-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51490207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03753ZMedicare PIN